Cardiovascular Business - October/November 2007 - (Page 31) es—often by a factor of two. A diagnostic EP case is a two-hour procedure, and a complex interventional procedure can last between three and five hours. In comparison, a diagnostic coronary case is a 30- to 45-minute procedure, and interventional cases last between 60 and 90 minutes. But the challenges of EP aren’t the only factor complicating the cath business. Two satellite hospitals have opened cardiac cath labs and usually retain the straightforward, non-complex cases, so Methodist-DeBakey patients tend to be more complex with greater co-morbidity than in the past. Patient length of stay is longer. Ultimately, the volume of EP and peripheral vascular work has not offset the loss of coronary procedures, says Dunn, and it requires more resources to complete fewer cases. One survival mechanism for the cath lab is to change its imaging arsenal. “We used to take a cookie cutter approach to imaging equipment, with each lab a clone of the others. Now, we need equipment that supports peripheral vascular, EP and coronary procedures,” explains Dunn. The center’s eight cath labs are outfitted with a variety of Siemens Medical Solutions imaging equipment. Two labs are outfitted with the Axiom Artis dTC, a 30 x40 cm large plate system that facilitates imaging of the carotids and peripheral vascular anatomy. Two labs house Siemens bi-plane systems and provide the flexibility to handle both diagnostic and interventional procedures and EP operations. The remaining four rooms are equipped with the Axiom Artis dFC, a universal angiography system. Inventory management is evolving as well. “An EP ablation catheter is as expensive as a drug-eluting stent,” Dunn points out. The key difference for bean counters is that vendors allow labs to consign drug-eluting stents, so they need not be counted as inventory. Dunn is working on similar arrangements with catheter vendors, but so far, only one of the hospital’s five vendors has agreed to the consignment arrangement. One potential fix is RFID technology that would allow the lab to easily track and manage its inventory. “It’s pretty pricey,” admits Dunn, “but could help us better manage inventory and limit overstocking.” In addition, the radio trackers minimize loss. Another piece of the management puzzle is staff. Methodist-DeBakey Heart Center aggressively promotes cross-training for EP, rewarding staff who siemens axiom artis dfC universal angiography system takes center stage in four of the eight cath labs at Methodist-Debakey Heart Center in Houston. the floor-mounted interventional imaging system has a slim-line C-arm allowing for flexible positioning around the patient. complete the curriculum with a $2,000 bonus. Cross-training increases flexibility among staffing and allows the site to supplement its procedure load with additional EP cases. The business growth model PinnacleHealth in Harrisburg, Penn., operates a high-volume cardiac cath business, performing nearly 5,000 procedures annually in its seven suites. Like other cardiac cath labs across the country, PinnacleHealth is facing declining coronary case volumes. The primary reason for the tough environment is a static patient load; area cath labs are competing for the same patients. And patients are not turning to the cath lab as fast as in the past. That may be because preventative measures are working and helping some patients delay coronary stenting. In addition, recent research promotes medical management over stenting for some patients. The hospital does have a key advantage; it participates in a considerable amount of clinical research. Research keeps us on the cutting edge, says Director of Invasive Cardiology Kate Acquaviva. For example, PinnacleHealth had its feet in the peripheral vascular business earlier than many of its colleagues, so as coronary volume dropped, peripheral vascular work helped fill the gaps. The ticket to success in the current environment, says CardiovascularBusiness.com Cardiovascular Business 31 http://www.CardiovascularBusiness.com
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