A cost savings with an ad hoc strategy of PTCA could not be consistently demonstrated. The cost advantage of an ad hoc approach may be most readily realized in clinical settings where the intrinsic risks are low (e.g., stable angina) or in which the device used carries a reduced risk of complications (e.g., stenting), because even a small increase in the complication rate will negate any financial advantage of an ad hoc approach.

The Level I trauma service is a conduit for patients coming into the hospital that provides a significant remuneration to the subspecialty services. Trauma surgeons are able to bill much less than many of their subspecialty colleagues despite expending significantly greater amounts of time and effort in the care of these patients. Strategies for improved reimbursement for trauma surgeons must be devised or trauma surgery will suffer the same fate as other areas of surgery, losing our brightest and best to more financially sound subspecialty services such as radiology and orthopedics.

The economic impact of PTCA salvage techniques depends on their clinical effectiveness, costs and revenues. In reimbursement systems dominated by DRG payers, salvage techniques are not rewarded, whereas complications are. Under capitated systems, the level of clinical effectiveness needed to achieve cost savings is probably not achievable in current practice. Further studies are needed to define equitable reimbursement schedules that will promote clinically effective practice.