Cardiovascular Business - January/February 2009 - (Page 6)

electrophysiology roundtable l Cannom u Haines s Morin David Cannom, MD, director of cardiology at Good Samaritan Hospital, Los Angeles, Calif. David. E. Haines, MD, chairman of cardiovascular medicine at William Beaumont Hospital, Royal Oak, Mich. Daniel Morin, MD, director of electrophysiology research at Ochsner Health System, New Orleans, La. being a huge component of the cost of providing our service. If your hospital does a percentage overhead based on inventory cost, it looks very expensive. If you use other formulas for assessing overhead, then it looks relatively profitable. Depending on how the cost accounting is done at the individual institutions determines whether heart rhythm is an area that they want to support or not. n Andrea Natale, MD, The big potential for growth is in ablative therapies, especially in complex arrhythmias. Device therapy has reached a plateau, as has been mentioned. Also, the success of the EP lab depends on the experience of the operator and we have increasingly more and more highly trained electrophysiologists who are able to manage these complexities. With highly trained operators, advanced technologies and a better understanding of the pathology involved with complex arrhythmias, the potential for growth is vast. n Wilkoff: I’d like to add that there is something that happens with implantable devices that doesn’t happen with most of the other parts of cardiovascular medicine. Once a person receives an implantable device, if the center is set up appropriately, these patients come back again and again. It becomes a relationship builder. So, while atrial fibrillation tends to recur, and maybe needs repeat business, a patient with an implantable device is your patient for life—if you develop that relationship properly. implantations. But they are not making decisions based on published criteria. The Heart Rhythm Society has been working with CMS to establish criteria, but since there is no national coverage decision—since nobody had ever imagined that you needed to have a national coverage decision to say whether somebody is an inpatient or an outpatient— then it’s up to local carriers to decide what’s appropriate. I would make sure you document the comorbidities and have justification for inpatient status. : What should electrophysiologists pay attention to when planning to open a lab? l Steinberg: It’s good to ensure that your capacity is proportional to your projected volume. Especially as you initiate a program, you want to ensure you don’t overbuild or oversupply equipment. It is often necessary to educate referring physicians about proper indications for procedures and devices, proper indications for consultations and referrals. l Cannom: I am very concerned that institutions are performing more procedures than they can safely do, particularly in atrial fibrillation ablation, without the experience or infrastructure to take care of patients who have a rare complication. I am not that interested anymore in seeing more programs open up in large cities. If you are going to set up a program in an underserved area, you need a huge institutional commitment to do these difficult procedures and you need someone that’s very experienced. u Haines: Fellows just out of training generally build their EP practice with bread-and-butter activities. Just for growing the business, the quick turnaround procedures are obviously the most profitable. A 90-minute AV node reentry ablation doesn’t pay a whole lot less than a five-hour A-fib ablation. n Natale: That will change, however, in 2009 when new Medicare rules will reimburse significantly less for outpatient procedures. CMS has criteria that you have to follow in terms of patient : What other ways can an EP center become more profitable? s Morin: You have to be sure that you are billing appropriately. Whether or not patients get appropriately coded as inpatient admission or inpatient observation makes a big difference in reimbursement—$1200 per case at our institution. n Wilkoff: The Recovery Audit Contractors (RACs) of the Centers for Medicare & Medicaid Services (CMS) have focused on the inpatient/outpatient status of defibrillator 6 cardiovascular business January/February 2009

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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