Office-based endovascular suite is safe for most procedures

Jain, Krishna M.; Munn, John; Rummel, Mark; Johnston, Dan; Longton, Chris

doi:10.1016/j.jvs.2013.07.008

Cited by 55 publications

(29 citation statements)

References 24 publications

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“…This transition in practice patterns may be attributed to institutional pressures to reduce inpatient hospital length of stay as well as evolving changes in reimbursement policies. Therefore, this study may have underestimated the frequency of endovascular therapies for claudication, given continuous growth in the overall volume of endovascular procedures performed in outpatient centers . It is also important to note that previously reported declines in rates of amputations are no longer apparent from 2007 to 2011, raising the issue of further necessity to improve means of early identification and treatment of patients with limb ischemia .…”

Section: Discussionmentioning

confidence: 91%

Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011

Kim

Swaminathan

Minutello

et al. 2015

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 91%

Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011

Kim

Swaminathan

Minutello

et al. 2015

Cathet Cardio Intervent

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“…This transition in practice patterns may be attributed to institutional pressures to reduce inpatient hospital length of stay as well as evolving changes in reimbursement policies. Therefore, this study may have underestimated the frequency of endovascular therapies for claudication, given continuous growth in the overall volume of endovascular procedures performed in outpatient centers [17]. It is also important to note that previously reported declines in rates of amputations are no longer apparent from 2007 to 2011, raising the issue of further necessity to improve means of early identification and treatment of patients with limb ischemia [18,19].…”

Section: Discussionmentioning

confidence: 92%

TCT-540 Trends in Hospital Treatments for Peripheral Arterial Disease in the United States and Impact of Payer Status on Quality of Care and Outcomes, 2007-2011

Kim

Swaminathan

Minutello

et al. 2014

Journal of the American College of Cardiology

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Objective: This study sought to identify the temporal trends of presenting diagnoses and vascular procedures performed for peripheral arterial disease (PAD) along with the rates of procedures and in-hospital outcomes by payer status. Background: Previous studies suggest that patients with Medicare, Medicaid, or lack of insurance receive poorer quality of care leading to worse outcomes. Methods: We analyzed 196,461,055 discharge records to identify all hospitalized patients with PAD records (n 5 1,687,724) from January 2007 through December 2011 in the Nationwide Inpatient Sample database. Results: The annual frequency of vascular procedures remained unchanged during the study period. Patients with Medicaid were more likely to present with gangrenes, whereas patients with Medicare were more likely to present with ulcers. After adjustment, patients with Medicare and Medicaid were more likely to undergo amputations when compared with private insurance/HMO (OR 5 1.13, 95% CI 5 1.10-1.16 and OR 5 1.24, 95% CI 5 1.20-1.29, respectively). Patients with both Medicare and Medicaid were less likely to undergo bypass surgery (OR 5 0.82, 95% CI 5 0.81-0.84 and OR 5 0.87, 95% CI 5 0.85-0.90, respectively), but more likely to undergo endovascular procedures (OR 5 1.18, 95% CI 5 1.17-1.20 and OR 5 1.03, 95% CI 5 1.01-1.06, respectively). Medicare and Medicaid status versus private insurance/HMO was associated with worse adjusted odds of in-hospital outcomes, including mortality after amputations, endovascular procedures, and bypass surgeries. Conclusions: In this analysis, patients with Medicare and Medicaid had more comorbid conditions at baseline when compared with private insurance/HMO cohorts, were more likely to present with advanced stages of PAD, undergo amputations, and develop in-hospital complications. These data unveil a critical gap and an opportunity for quality improvement in the elderly and those with poor socioeconomic status. V C 2015 Wiley Periodicals, Inc.

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“…Office based labs (POS 11) are accredited to perform diagnostic coronary angiograms without intervention and diagnostic and interventional peripheral procedures on Medicare patients. Diagnostic and lower‐risk endovascular procedures such as angiograms, coronary/peripheral vascular interventions, and electrophysiologic device implants can be safely preformed in freestanding and office‐based laboratories . Some commercial payers allow coronary interventional procedures, pacemakers, and internal cardioverter defibrillator placement in these settings as well.…”

Section: Economics Of Outpatient Facilitiesmentioning

confidence: 99%

SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances

Blankenship

Choi

Das

et al. 2019

Cathet Cardio Intervent

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This article is intended for any physician, administrator, or cardiovascular catheterization laboratory (CCL) staff member who desires a fundamental understanding of finances and economics of CCLs in the United States. The authors' goal is to illuminate general economic principles of CCL operations and provide details that can be used immediately by CCL leaders. Any article on economics in medicine should start by acknowledging the primacy of the principles of medical ethics. While physicians have been trained to act in the best interests of their patients and avoid actions that would harm patients it is vitally important that all professionals in the CCL focus on patients' needs. Caregivers both at the bedside and in the office must consider how their actions will affect not only the patient they are treating at the time, but others as well. If the best interests of a patient were to conflict with any recommendation in this article, the former should prevail. Key Points To be successful and financially viable under current payment systems, CCL physicians, and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture. Optimizing a CCL's operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation. Expense reduction depends on efficiency (on‐time starts, short turn‐over time, smooth day‐to‐day schedules), identifying cost‐effective materials, and negotiating their price downward. Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee‐for‐service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues. New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the “halo effect” of collateral services that accompany the new procedure. Fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.

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Office-based endovascular suite is safe for most procedures

Cited by 55 publications

References 24 publications

Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011

Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011

TCT-540 Trends in Hospital Treatments for Peripheral Arterial Disease in the United States and Impact of Payer Status on Quality of Care and Outcomes, 2007-2011

SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances

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