Squeezing savings from PCI

In a competitive environment, how can a hospital protect its profit margins? With PCI, shortening the length of stay and reducing risk may provide answers.

Steven P. Marso, MD, an interventional cardiologist at St. Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues argue that transradial access provides cost savings, and they back that with data. In a study published in the March issue of the American Heart Journal, they demonstrated that using the transradial approach saved a center on average $553 compared with transfemoral PCI. They based the analysis on data from the Premier research database, which includes about 20 percent of all acute care hospitalizations in the U.S. from a diverse group of hospitals.

Day-of-procedure costs varied little between approaches. Marso et al attributed much of the savings to the 0.31 day reduction in length of stay associated with the transradial approach.  A decrease in bleeding complications also played a lesser but still important role in cost savings. Factoring in cases where patients were at high risk of bleeding complications, the average cost savings grew to more than $1,000.

“From a hospital perspective, transradial is one way they can drive down institutional cost,” Marso said in an interview with Cardiovascular Business.

At ACC.13, researchers from the Cleveland Clinic gave attendees a peek at another strategy for predicting PCI costs in a proof-of-concept poster presentation. Matthew Bunte, MD, of the Cleveland Clinic, and his colleagues modeled costs using Medicare administrative claims data for PCI patients at the Cleveland Clinic by stratifying them into one of three cost categories: low, medium and high.

Their goal was to develop a bundled payment model that could predict cost using pre-procedural data. If it proves robust, the model ultimately will inform hospital administrators who among their PCI patients is likely to fall into the resource-intensive category. That knowledge may help them negotiate prices with private payers, for instance, that offer favorable profit margins.

Are the strategies of the past still working for you? If not, where and how can your cath lab adjust? We will continue to share insights from other institutions. In the meantime, feel free to contact us with potential solutions and concerns.

Candace Stuart

Cardiovascular Business, editor