Cath lab alley-oop: 5 slam-dunk ways to cut cost, add value

ATLANTA—Opportunities exist within many cardiovascular programs to trim out costs and add value. But where? Suzette Jaskie, president and CEO of MedAxiom Consulting, offered five “slam dunk” approaches June 13 at the Cardiovascular Service Line Symposium in Atlanta.

“Don’t start with cost cutting without first talking about how clinical decisions drive the process,” she advised. “Your clinical standard is No. 1 and sits in the middle and is protected.”

Physician consensus about that standard, and their engagement, support and leadership are a must, as is transparency and confidentiality, she said. Hospitals may hesitate to be transparent about data with physicians, and physicians may need to be aware of the complexity of data on the hospital side.

Hospital data can be messy. “If you go to the table with that understanding in the first place, you will get farther.”

Ultimately, cost-saving decisions will be made by a team of not just physicians but also administrators and staff.

Here are five strategies:

Marry administrative and clinical processes

Coding patient type and status are administrative tasks. On average, the difference between an inpatient and outpatient case is $4,000, she pointed out, but coding for this is often done without clinical input. Comorbidities coded on admission prevent penalties on quality measures, but adding them during hospitalization may lead to penalties.

Using a case of a patient being implanted with an implantable cardioverter-defibrillator with a catheterization as an example, she showed that a hospital in one market would be reimbursed $22,225 for an outpatient procedure and $39,018 for an inpatient procedure.

Use process, staff and IT to align clinical and administrative processes. Jaskie offered as a solution a preadmission clinic in the hospital to ensure administrative and clinical readiness before a procedure. That would include a patient visit, preloading orders, recording comorbidities on admission, insurance preauthorization, case timeliness to ensure preprocedural processes are done and patient education.

Provider resource management

Who is doing what when? Adding predictability and reliability in operations through techniques such as block scheduling can improve the productivity of cardiologists as well as cath labs or electrophysiology (EP) labs, said Jaskie.

“Even if all we do is get rounding done earlier in the day, so we discharge on time and we start the cath lab and the EP lab on time, it will make a difference.”

Reduction in unnecessary variation

First, identify variation and then reduce it. That requires data, access to data and analytics. “You have to have the forums and people to dig into the data,” Jaskie said.

Armed with data, use resources—processes, staff and IT—that already exist, but perhaps deploy them differently. Look at not only volume but selection of supplies to reduce cost. That may mean fewer devices and pharmaceuticals and changes in use of supplies. Her program, for instance, once saved $900,000 by getting physicians to agree to make an isotope-related change.

Charge master management

Keep your charge master up to date. It is unrealistic to try to look at each of the thousands of codes individually. Targeted scrutiny may help weed out lost opportunity, for instance, with a review of bundled codes to ensure they were properly adjusted.

If you charge less than Medicare, you will be paid less than Medicare, she pointed out. A change in one code saved a program $600,000.

Capital anticipation and management

The approval process for service line capital investment projects is different from other types of budgeting. It requires a pro forma step and committees and may entail battles over limited capital. That means looking ahead and anticipating what will be needed to maintain existing infrastructure or to build anew.

Look at capacity and optimize existing infrastructure. “You don’t always need a new cath lab,” Jaskie said.  

Anticipate and communicate. Many programs recognize that novel approaches such as renal denervation offer growth opportunities. “We know that, but we can’t expect our CFO to know that,” she said. Think through what inventory, equipment or EHR additions a renal denervation program would require and articulate the program needs and benefits.