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Lower Extremity Endovascular Intervention: Can Hospitals Afford This New Technology?

Maciej L Dryjski¹, Maureen S O'Brien-Irr¹, Hasan H Dosluoglu², Linda M Harris.^1
1University at Buffalo and Kaleida Health, Buffalo, NY; ²University at Buffalo, Buffalo, NY.

OBJECTIVES: To evaluate the cost of endovascular intervention (EVI) for treatment of Peripheral Vascular Disease and to identify potential areas where adjustments can be made to improve hospitals profitability.

METHODS: A retrospective review of medical records of all patients who presented to a University Health System during 2005 for EVI was undertaken. Patients who underwent thrombolysis were excluded. Procedure Type, Setting, Admission Status and Financial Data were recorded. Statistical Analysis was completed using SPSS (Chicago Ill).

RESULTS: There were 184 cases. Atherectomy and Stenting were significantly more costly when performed in the Operating Room (O.R.) than in Radiology (Table 1). Reimbursement was significantly higher for In-Patient (IP) Admissions (p=.000). Costs were lowest when EVI was done in radiology on an ambulatory (AMB) patients and highest when done as an IP in the O.R. Contribution Margins (CM) were significantly higher for IPs. Net Profit (NP) was appreciated only for EVI done as an IP in radiology (Table 2). Reimbursement, CM and NP were significantly lower among private pay patients (Table 3). 30 day hospital re-admission following AMB EVI was 7(6%).

CONCLUSIONS: EVI can be very costly. To make this more affordable, clinical pathways should be developed to designate a “Plasty First” approach with stenting and atherectomy reserved for non-amenable or failed cases. Vascular surgeons should have unhindered access to radiology as it is less costly than the O.R. Administrators must re-negotiate contracts with private insurers to assure commensurate reimbursement for AMB procedures to make it fiscally acceptable to offer EVI on an ambulatory basis.