Cardiovascular Business - January/February 2009 - (Page 5)

about Profits, Procedures and Patients Moderator: C.P. Kaiser, Editor Cardiovascular Business – : It’s been said that the electrophysiology lab is a loss leader for cardiology departments. Given the current economic climate, what can be done to ensure the EP lab remains a viable economic success? l Jonathan S. Steinberg, MD: I don’t agree with the statement, although it’s been an historical canard that was bandied about, often by hospital administrators. It relates to an era that doesn’t exist anymore, when patients spent much more time in the hospital. Nowadays, on the contrary, EP is very lucrative for institutions. The procedures are complex but reasonably well reimbursed. Hospital stays are short or ambulatory. In general, they can be a profit leader for hospitals or cardiology divisions. n Bruce L. Wilkoff, MD: I agree that it is not the case any longer. The volume in the electrophysiology laboratory, although not growing robustly, has the potential to continue to grow as we have advances in both implantable devices and ablative therapies. In years past, coronary disease ran cardiovascular medicine in the hospitals, but coronary disease definitely is not what’s leading things now. l David Cannom, MD: It’s a complicated question. Los Angeles is an economic environment unto itself. We have a very high HMO penetration. If you depend on HMO reimbursement for complicated procedures, particularly atrial fibrillation (AF) ablation, you would have a very difficult time economically. What we have been forced to do, as have other places, is renegotiate contracts with the HMOs. Routine ablations, such as simple AVNRT (AV nodal reentrant tachycardia), bypass tracts and atrial flutter, are clearly disappearing or being done at other places. When you depend on atrial fibrillation, as we do, it really can be very dicey because of the expense of the equipment and the time it takes to do the procedure. Dr. Daniel Morin performing an ablation procedure. s Daniel Morin, MD: I’d like to provide a regional contrast to Dr. Cannom’s view. We are the major EP force down here in Louisiana, and at a place historically very cath heavy. Recently, we had a consulting group that came into our place and identified— among all the different cardiology and hospital services—electrophysiology as a source of future revenue growth. u David. E. Haines, MD: At our institution in Michigan, the interventional volume is falling. We get some backfill from peripheral intervention, but those numbers are flat. The only growth area within cardiology is noninvasive imaging, predominantly CT angiography, and EP—and A-fib is driving EP. The device numbers are flat right now. One of the things about the profitability, or lack thereof, is that it’s very dependent on the cost accounting in the individual institution. There is no question that heart rhythm services have a substantial contribution margin and how you determine the profitability is all in the calculation of overhead expenses. We are way lopsided in terms of devices cardiovascularbusiness.com cardiovascular business 5 http://www.cardiovascularbusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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