SCAI document provides advice on cath labs’ financial viability

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James C Blankenship

The Society for Coronary Angiography (SCAI) has issued a statement, endorsed by the Alliance of Cardiovascular Professionals (ACVP), providing advice on the economics of cardiovascular cath labs and how they can be financially viable.

The aim of the document is to “illuminate general economic principles of CCL [cardiovascular catheterisation laboratory] operations and provide details that can be used immediately”.

James C Blankenship (Geisinger Medical Center, Danville, USA) and colleagues say: “Understanding the economics of cath labs is essential for physicians, administrators, and other cardiac cath lab personnel as they strive to balance the best possible patient care with fiscal constraints and competing demands for resources.”

Published in Catheterization and Cardiovascular Interventions, the recommendations include details on how to align strategy, personnel, and culture with leadership, organisation, and processes, and how to optimise profitability, as well as on the relationship between efficiency and reducing expenses.

Revenue optimisation, the authors suggest, “requires accurate documentation and coding of procedures, comorbidities, and complications. In fee-for-service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues.” Additionally, they say, a “halo effect” from collateral services, combined with negotiating lower prices with vendors, can be used to aid the introduction of expensive new procedures that improve patient care.

The document offers strategies for “surviving and thriving” in an era of health reform, with tips on how to maximise revenue in fee-for-service reimbursement systems, and on how to minimise both cath lab and non cath lab expenses. It explains the economics of new procedures, and offers instructions on “how to make them at least break even”.

And the statement advises that “fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.”

According to the authors, service expansion is crucial. They point out that, as the volume of interventional coronary procedures has declined, structural procedures have stabilised CCL volumes and revenues. “When clinically appropriate, increase a CCL’s scope of practice to include peripheral procedures, implantable rhythm recorders, pulmonary artery pressure monitoring devices, and other new procedures.”

But the statement cautions against adopting new technology before it has proved its worth, and proposes that the cost-per-case can be reduced by maximising the number of procedures performed per piece of equipment per day, given that capital equipment is a fixed expense. This can be achieved by “minimising CCL down time, and operating the CCL during evenings and weekends”.

A change in the focus of reimbursement models from fee-for-service to patient centred quality measures and value has created opportunities and challenges for outpatient facilities, say Blankenship et al. They predict an expanding role for outpatient centres as procedures become less invasive and there is less conversion to open surgery: “In the future, outpatient facilities will likely offer lower cost, high quality, and higher patient satisfaction compared to inpatient facilities for elective cardiovascular procedures.”

To maximise quality, the statement proposes that three measures should be addressed—structure, process, and outcomes—both at cath lab level and at the level of individual physicians. However, it cautions: “Physicians and administrative leaders must ensure that strategies to control costs … do not compromise quality or safety.”

Blankenship et al conclude: “An efficient CCL can provide superb cutting-edge patient care, excellent patient experience, extreme employee workplace satisfaction, and financial support for other less profitable hospital programs.”

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