Coronary Intervention: Financial Factors Facing Cath Labs

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  The impact on cath labs of the increasing use of coronary CT angiography is still being debated. Coronary stent visualized with CTA. (Source: Philips Healthcare)

Recent trial results, multidetector CT and new and more uses for the services and equipment of the traditional cardiac catheterization lab are impacting the bottom line of facilities across the country. These and more factors may have temporarily decreased cath lab procedures, but experts in the field predict recovery—albeit a changing face for the cath lab.

An estimated 4.21 million patient cases were performed at 1,970 cardiac cath lab sites in 2006, according to a report from consulting firm IMV. This represents a 9 percent increase from 2002, which also indicates a slightly slower rate of growth (2 percent a year) than in previous years. The vast majority (89 percent) of procedures are cardiac-related and the remaining 11 percent are non-cardiac applications, such as carotid, iliac, femoral, run-off, renal and extremity studies.

From 2003 to 2006, the average device budget per cath lab increased 18 percent per year to $1.8 million, driven by the adoption of more sophisticated devices such as drug-eluting stents, according to the report. Also, the proportion of sites with capital budgets of over $1.5 million has increased from 14 percent in 2000 to 30 percent in 2006, as hospitals invest in new technology such as flat panel digital detectors.

Growing the business


With that kind of investment, it’s no wonder that many cath labs are growing their business by making it possible for more subspecialists to use the equipment.

To continue to succeed and grow, cath labs have to become multi-imaging destinations, according to Steven Yakubov, MD, an interventional radiologist with OhioHealth. “They have to include CT angiography suites, maybe MRI, and interventional procedures. The cath lab of the future is a multi-imaging destination.”

“We’re certainly using our labs for multiple reasons by multiple users,” says Stephen Green, MD, associate director of the cardiac catheterization lab at North Shore University Hospital in Manhasset, N.Y. His facility was ahead of the curve when it began doing peripheral work in 1996. Newer lab users include vascular surgeons, interventional radiologists and neurointerventional radiologists. Labs have more functionality today so more physicians can use the equipment for endoscopic procedures, clips and coils in the head and more—all in the same lab, he says.

Another benefit of more modern equipment is the capabilities offered by information systems. They’re so good these days, Green says, that they can help with the bottom line by allowing users to track diagnostic volumes and look for various trends and patterns. With these advantages, “business is not going to get smaller.”

The other challenge for individual facilities is keeping their patient population growing. “The economics of the community you’re in is important, plus the level of competition,” says Yakubov. The more labs in your area, the more you have to show that you have superiority in these multidimensional imaging systems. “Your lab’s physicians all need to be experts in their field for that cath lab to stand out in an area where there are multiple labs competing for the same patient base.”

Despite the new and expanded uses for cath lab resources, there are forces at work chipping away at revenue. Recent study results are part of the current “perfect storm” in cardiology that’s forcing reevaluation of cath labs, says Thomas H. Maloney, RT, director of clinical education for Boston Scientific. A series of trials all came in a sequence that has driven stent utilization down from 90 percent to 60 percent and a measured reduction of 10 percent in cath lab procedures between September 2006 and September 2007. Recovery from that decline will be gradual but steady in 2008, he predicts.

Part of that recovery requires savvy about how to increase volumes. Cath labs need to perform new peripheral, neurological and structural heart procedures, Maloney says. “We’re seeing the advent of hybrid labs. We need other, new procedures to replace what we’ve lost.” Most cardiology meetings now focus on carotid stenting, structural heart disease and aortic valve replacement, among other techniques that will help cath labs’ recovery.

There is good reason for the studies and trials that relate to cardiac catheterization labs, says Bonnie Weiner, MD, an internist and interventional cardiologist