Cardiovascular procedures are increasingly moving from hospitals to outpatient settings, and are being performed in ambulatory surgery centers. That change can save the patient, provider and payer money by allowing the patient to avoid an overnight hospital stay.
During a May 26 webinar sponsored by Cardinal Health, and hosted by Becker's Hospital Review, industry experts discussed the benefits of an outpatient setting and offered advice to providers considering shifting their cardiovascular practice to an ambulatory service center or office-based lab.
The speakers were:
- Matthew Comstock, DO, an interventional cardiologist and founder of the Tulsa (Okla.) Cardiovascular Center of Excellence
- Jared Leger, RN, CEO of Arise Vascular
Five key takeaways from their discussion:
1. The advancement of outpatient technology has driven the shift of coronary intervention from the hospital setting to ASCs. Smaller devices mean smaller incision sites that are quicker to heal, reducing bleeding risk to patients, according to Dr. Comstock. Reduced risk and fewer complications leads to increased patient satisfaction and lower overall cost.
Dr. Comstock said his practice uses Cordis' femoral vascular closure device to reduce bleeding complications and increase early ambulation during percutaneous coronary intervention, or PCI, procedures. Such technology has made performing coronary intervention procedures safer for patients, increased patient satisfaction by reducing recovery times and allowed providers to switch appropriately selected patients to an ASC setting.
2. Switching to an outpatient setting can save Medicare and its beneficiaries millions of dollars per year. The average reimbursement rate for the two most common PCI procedures in a hospital is around $12,000 per case, according to Mr. Leger. Those procedures in an outpatient setting cost about $6,000 less per case.
There are about 700,000 Medicare PCI procedures performed each year, and the centers for medicare and medicaid services has estimated that moving about 5 percent of PCI procedures from hospital outpatient settings to ASCs or OBLs would save Medicare about $20 million per year and save beneficiaries $5 million per year in out-of-pocket costs, Mr. Leger said. A poll conducted by Arise Vascular found that as many as 20 percent of PCI procedures currently performed in hospital outpatient settings can be moved safely to ASCs.
"As a physician, we have an obligation to not harm our patients. To me, this means both medically and financially. If I can perform the same service or procedure without any negative impact on patient outcomes for a fraction of the cost to both the patient, the insurance company and the taxpayer, then I'm doing the right thing," Dr. Comstock said.
Mr. Leger discussed the reimbursement differences between an ASC, OBL and a hospital outpatient department. While ASCs and OBLs are reimbursed less than a hospital outpatient department, they can increase profits with streamlined operations and cost management.
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3. Multiple clinical trials have shown that the outpatient setting is safe for coronary intervention procedures. Providers have been performing same-day discharge for PCIs in hospital outpatient settings for the last decade, Dr. Comstock said. Studies have shown that there is no significant difference in major adverse cardiac events when procedures are conducted in an ASC versus a hospital outpatient setting with appropriate patient selection.
4. The ASC setting allows physicians to have more control over their work, as physicians typically have an ownership stake in their ASC, and patients generally prefer ASCs over hospitals, Mr. Leger said.
All of Arise Vascular's facilities are physician-owned, giving physicians more of a voice and more control over their schedules.
"We are of the thought that healthcare was always intended to be run by physicians and if the physician is successful, then we're all successful," Mr. Leger said.
Patients tend to prefer ASC settings over hospital settings because they are generally lower cost, patients aren't exposed to acutely ill patients as they are in hospitals, parking is easier and the admissions and discharge processes are easier, Mr. Leger said.
5. Always let financial forecasting data drive the decision to open either an ASC, OBL or hybrid, Mr. Leger said. ASCs and OBLs are similar in that they both provide procedures in outpatient settings, but they are regulated differently and are financially very different. The decision as to which business model would work best should be based on what type of procedure will be most commonly provided, Mr. Leger said, as different procedures are reimbursed differently in an ASC versus OBL setting.