Texas Health Arlington Memorial Hospital: Becoming a Center of Excellence

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 - Texas Health Arlington Memorial Hospital
Texas Health Arlington Memorial Hospital in Arlington, Texas

Advanced electrophysiology (EP) technology is a key component in improving patient care and physician productivity. Texas Health Arlington Memorial Hospital in Arlington, Texas, has implemented the Sensei X Robotic Catheter System in advancing a Center of Excellence.

Developing a center of excellence

Within the last two years, Texas Health Arlington Memorial became the first Texas hospital named a Cycle III Chest Pain Center and the first ever named an Acute Heart Failure Center —both by the Society of Chest Pain Centers. With an intensive outpatient clinic reaching out to the community and educating patients about heart failure, readmission rates dropped from 7.3 percent to 2.8 percent.

The 369-bed facility sits in the middle of the Dallas-Fort Worth (DFW) metroplex, serving a population of about 700,000 and offering a full range of services to the community. William Nesbitt, MD, a cardiac electrophysiologist, is key in advancing the Center of Excellence program.   

Several years ago, Nesbitt surveyed the market and noted a need in the community for a comprehensive arrhythmia center. "There was a lack of EP services within the entire central DFW metroplex," he says. "Patients had to go to either Dallas or Fort Worth. It was then that we began to enhance the program on our campus."

"Dr. Nesbitt's vision was closely aligned with the hospital's vision," says Corey Wilson, administrative director of business development and support services for Texas Health Arlington Memorial. "He researched the market, understood the community's needs and the resources—both in staff and technology—that would be necessary to give the best care to arrhythmia patients."  

As the program grew, Nesbitt, Wilson and other hospital personnel ensured that both quality patient care and sound fiduciary judgment would be at the forefront of each decision. One technology sought by Nesbitt was a robotic catheter system that would allow the operator to manipulate a catheter inside the heart while seated at a console outside the EP lab.

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Table 1. Patient Growth Pre & Post Flexible Robotics Pre-Flexible Robotics Post-Flexible Robotics
  2009 Change 2010 Chg YOY
Inpatients: Left Atrial EP Procedure 7 -1 6 -14%
Outpatients: Left Atrial EP Procedure 79 66 145 84%
Total Patients: Left Atrial EP Procedure 86 65 151 76%
Total Robotic Patients: Left Atrial EP Procedure 0 82 82  
Total EP Patients 494 49 543 10%
Table 1a. Flexible Robotics Financial Analysis Intial Pro Forma Adjusted Pro Forma
Net Present Value $1.3M $2.8M
Payback Period (Years) 2.5 0.9

"My main criteria for selecting the technology needed for advancement of the EP program were its ability to contribute to our high standard of quality, ease of operation, ease of implementation and cost-effectiveness," Nesbitt says.

"From a business standpoint," Wilson says, "we wanted to increase patient capacity on the campus, because there was a six- to eight-week waiting list. The new technology had to not only allow more patients to be seen, but also needed to afford Dr. Nesbitt the energy reserve through increased ease of operation to treat those additional patients. The robotic catheter system accomplished both."

Conservative financial pro forma

Wilson's financial pro forma was conservative. The 2009 baseline number of left atrial EP patients was 86. He projected that the flexible robotic system would result in an additional two patients per month the first year (2010). "Because of our backlog, we knew the need was there and the market would support our conservative projection. The following year, we projected three additional patients per month and then four per month after that," Wilson says.

"Since payors do not provide additional reimbursement for procedures carried out with the robotic system, the return on investment [ROI] was based on the incremental increase in the number of patients served," Wilson says. The conservative pro forma did not consider the "halo effect" of any increase in the number of implant procedures resulting from the overall increase in the number of patients seen.

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Table 2. Physician Daily Case Capacitys Pre-Flexible Robotics Post-Flexible Robotics
  Wed Thurs Wed Thurs
Left Atrial EP Procedure Patients 2 1 3 2
EP Implants (ICD, Pacemaker) Patients 1 3 2 4

When comparing actual results to the pro forma, the ROI projection was exceeded. Rather than accommodating an additional 24 patients the first year, the EP lab saw an increase of 65 patients—a 76 percent year-over-year change. "Program growth exceeded all the numbers