7 Steps to Implement Pacemaker Generator Insertion at an ASC
1. Recruit a credentialed cardiologist or general surgeon to perform the cases. Before you start purchasing equipment for these procedures, Ms. Sellers says your surgery center must have a cardiologist or general surgeon certified in pacemaker generator insertion. She was lucky enough to have certified general surgeons at the center prior to implementing the procedure. She says Medicare is reimbursing well for the procedure, making it a profitable addition to a surgery center if the administrator can negotiate favorable contracts with vendors and payors.
2. Select and negotiate a contract with a generator company. Ms. Sellers says her surgery center chose Medtronic as its generator company because the surgeons had positive experience with the vendor, but the important thing is to find a vendor that will negotiate a favorable contract with you. She says if a nearby hospital is performing the same procedure, the vendor may be willing to honor the same price they're giving the hospital.
Necessary equipment for the procedure includes a C-Arm and lead jackets, a generator analyzer and a crash cart, as well as supplies such as a pacemaker analyzer cord, a single chamber generator kit and a dual chamber generator kit. Ms. Sellers says the generator kits run about $3,500-$3,900 (for a single chamber) and $4,100 to $4,900 (for a dual chamber).
3. Work with payors to carve out implant costs. Ms. Sellers says Medicare reimburses relatively well for pacemaker generator insertions, but surgery centers must still negotiate profitable contracts with payors. "With our in-network insurance companies, we asked for carve-outs before we started doing the procedures at the center, and they came back with a certain amount they would reimburse us for," she says.
4. Ensure appropriate staff members are ACLS-certified. Nurses supporting your surgeons should be Advanced Cardiovascular Life Support-certified and supported by a capable scrub technician. She says her surgery center was lucky in that all nurses were already ACLS-certified prior to implementing the procedure.
5. Provide adequate staffing for patient recovery. If patients are coming to the surgery center for an initial pacemaker insertion, they should be monitored in the PACU with a prolonged stay, Ms. Sellers says. She says this prolonged stay is not necessary if the patient is having an existing generator changed. The need for prolonged stay means the ASC must staff the PACU with enough post-op nurses for extended recovery.
6. Send patients home with a monitor for 23-hour observation and a pacemaker card. Ms. Sellers recommends recruiting a local cardiologist and asking him or her to see the patient post-operatively. In her center, the cardiologist sends over a tech who gives the patient a halter monitor that monitors their heart rate for 23 hours. If the patient's heart experiences abnormal pacing, the monitor sends an alert to an operator who calls the patient to check in.
Ms. Sellers says each patient is also given a "pacemaker card," which the patient keeps in his or her wallet to present whenever they undergo medical care. "This card helps the provider know what kind of pacemaker they have, because there are several kinds," she says.
7. Make sure a crash cart is in the OR for all cases. Because the procedure involves pacing the heart, Ms. Sellers says a code cart must be present in the operating room during the insertion. She says your surgery center may have to invest in a crash cart if you don't use one for other procedures.
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