Repair, Replace or Refer?

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 - Repair

Cardiac imaging equipment doesn’t always pay for itself anymore. What should providers do about that aging suite?

Economic uncertainty continues to rattle U.S. healthcare, but the spring of 2013 will find at least one cardiology administrator upbeat about the years ahead. Rosemary Owen, manager of cardiovascular labs at the 523-bed, seven-cath lab Providence St. Vincent Medical Center in Portland, Ore., expects business to pick up—or at least hold steady—largely on the strength of a key investment: a $2 million-plus biplane mixed cardiovascular x-ray system that will be used to treat patients with cardiovascular diseases. Planning started last summer with a target completion date of this spring.

“It’s a big opportunity because it will lead to greater satisfaction among the physicians,” explains Owen, adding that the redesigned and re-equipped room was, until now, her oldest. “[Physicians are] going to bring in business, because they can work on complex cases that this room wouldn’t support before. Now that we’ve got the imaging to show very small vessels sharp and clear, nonsurgical interventions are a stronger option.”

Owen’s experience may be instructive for heart and vascular departments and practices hanging on to old imaging equipment while waiting, possibly in vain, for healthcare economics to stabilize if not improve.

Cold-facts case

Owen first had an inkling the outdated equipment’s time had come when repair technicians, who were engaged by a long-term service contract, started having difficulties locating replacement parts. She had them pull up detailed service data. The records showed that problems, issues and downtime had increased markedly and predictably according to age and utilization. Documentation in hand, Owen pulled together stakeholders, wrote a business plan and presented a requisition to hospital leadership. She also had to get a green light from Oregon’s health policy office.

Improvements to care quality are a given with the changes, says Owen. For instance, the replacement is expected to minimize radiation dose to patients and staff. She allows that the financial return on investment is harder to predict, but “we wouldn’t have gone forward with this if we thought our numbers were going to go down. Right now, we have the business to fill all seven rooms, and we certainly feel we can maintain, at least, and go from there.”

She also points out that, although the institution is not affiliated with a medical school, research and teaching are in its mission. “We can accommodate clinical trials; we have the right equipment to support it.” That can make for a persuasive point in a competitive grant proposal. 

Asked to name challenges she anticipates as the room goes from newly live to fully implemented, Owen points to three she knows from past experience: working out bugs that the manufacturer has never seen before (a previous project was plagued for weeks), comprehensively training technologists even on rarely used functions and, most vexing of all, avoiding buyer’s remorse over pricey software add-ons. “You always have physicians who hear the sales pitch from the vendor and insist they have to have just about everything,” says Owen. “Then you get it and they don’t use it.”

Private or bust

If unnecessary outlays are frustrating for hospital departments, they can be crushing to private cardiology practices. Joel Sauer, MBA, vice president of consulting for MedAxiom, a cardiology consultancy firm in Neptune Beach, Fla., notes that, eight years ago, not one of its members was employed by hospitals. In 2012, the count topped 60 percent and, Sauer says, it’s on its way to 80 percent if it isn’t there already. Imaging costs are just one of many pressures causing private practices to yield to acquisition offers from hospitals, but their sheer size suggests they may represent low-hanging fruit for the pruning. Does it ever make sense for a group to neither repair nor replace but, instead, sell off the big-ticket equipment and refer imaging procedures outside?

“Ever is a long time,” replies Sauer, “but when you’re hanging on to your private status by your fingernails, every dollar you can keep is good because it allows you to stay private.”

Sauer points to recent market studies showing that reimbursement’s movement from volume-based to value-based is causing cardiac CT and MR suites to morph from profit centers to cost centers—a factor that is forcing many private groups to “go over to the hospital side.” He