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an HMP Communications Holdings Company February 2017

How Does Your Cath Lab Stack Up? In this month’s article, we call on our colleagues at MedAxiom to share their findings from the 2016 Cath Lab Survey. The survey results demonstrate some very compelling findings that correlate closely to the observations seen in assessments conducted by MedAxiom and Terumo Business Edge as part of our Cath Lab Care Pathway Program. Cath labs across the country share many of the same concerns and challenges. As a result of this extremely dynamic and fast-paced environment, cath labs are facing a wide variety of issues which make managing margins and reducing costs an added challenge, a theme that was prominent in the recently concluded JP Morgan Healthcare Conference.

- Gary Clifton, Vice President, Terumo Business Edge

Brought to you by

Article reprinted with permission from Cath Lab Digest February 2017, Vol. 25, No. 2©2017 HMP Communications

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Have you wondered what other cath lab turnaround times are? Do programs really offer outpatient

cath procedures on the weekends? How successful have other programs been in implementing same-day discharge? Are cardiovascular (CV) dedicated picture archiving and communication system (PACS) and business managers becoming the norm? How are other programs fill-ing cath lab space left open from declin-ing elective percutaneous coronary inter-vention (PCI) volumes?

As consultants for MedAxiom, we can assure you that you are not alone in trying to find answers to these basic but elusive questions. To develop a survey to meet this critical need, MedAxiom partnered with Terumo in 2016. The intent of the cath lab survey was to collect qualitative data from those intimately involved in cath lab operations. The survey was writ-ten by former cath lab staff and leaders, and is structured around 4 key axioms:

•Organizational – Structure of theprogram

•Operational - Day-to-day runningof the lab

•Clinical Excellence – Level offocus and action quality, safety, and program development

•Transformational Actions –Leading work in the other threeaxioms

The survey was distributed byMedAxiom to their members and by Cath Lab Digest to readers. The survey consisted of 72 questions and received 40 responses. The survey was in depth and required participants to complete detailed questions about their pro-gram. The MedAxiom team is using the data as a directional tool to un-derstand what cath labs are focusing on today and need for tomorrow. The programs responding varied in size and mission, and included both commu-nity and academic programs. Programs had diverse clinical offerings, from elective PCI work to cardiac transplant programs. The common denominator was that all programs operated a cath lab. Each program that submitted a re-sponse received a report on how they benchmarked against the other partici-pating programs.

The survey closed at the end of 2016 and the MedAxiom survey team began review-ing the responses. Did they identify any interesting trends or unexpected responses? The answer to those questions was both yes and no. The first answer they found in-teresting was the survey group’s response under a question in the operations section of the survey. The question (Figure 1) read, “Does your cath lab have an organized clin-ical standards and policy committee?”

Although we were not surprised to find many programs do not have a for-mal means of reviewing clinical standards, standing procedures, and policy, this is a critical opportunity as payment models replace volume with quality and value. Cardiology programs have been inundated with information about payment models focusing on episodes of care. The newly approved cardiac bundles are an example of these new payment models. So how will a structure to review care process position programs for future success? Programs will need a vehicle to review current practices

and policies around cardiac procedures. A clinical standards committee could be the driver of this work. Clinical protocols should be vetted based on quality of out-comes to the patient, cost to the episode, and impact on the patient experience. If a past care model, test, or interaction does not provide value under these criteria, im-mediate consideration should be given to eliminating that practice. Top of the list for these committees should be review of variation in care/practices. A common ex-ample found in many cath labs is variation in bed rest times post procedure. If bed rest time is a physician-by-physician choice, not based on a practice standard, this in-troduces too much unnecessary variation. The end result is confusion to staff and patients, and potentially wasted resources. The structure to review and understand basic practices producing best outcomes is a hidden opportunity in many programs.

In the past, growth in cath lab capital in-vestments were a frequent and expected practice. The work done in the cath lab

How Does Your Cath Lab Stack Up? In this month’s article, we call on our colleagues at MedAxiom to share their findings from the 2016 Cath Lab Survey. The survey results demonstrate some very compelling findings that correlate closely to the observations seen in assessments conducted by MedAxiom and Terumo Business Edge as part of our Cath Lab Care Pathway Program. Cath labs across the country share many of the same concerns and challenges. As a result of this extremely dynamic and fast-paced environment, cath labs are facing a wide variety of issues which make managing margins and reducing costs an added challenge, a theme that was prominent in the recently concluded JP Morgan Healthcare Conference. - Gary Clifton, Vice President, Terumo Business Edge

Anne Beekman, RN, Vice President –Consulting, MedAxiom Consulting

Brought to you by

Denise Brown, Vice President – Business Intelligence Solutions and Senior Consultant, MedAxiom Consulting

We were not surprised to find many programs do not have a formal means of reviewing clinical standards.

Figure 1. Question 8. Does your cath lab have an organized clinical stan-dards and policy committee?

Top of the list for these committees should be review of variation in care/practices. A common example found in many cath labs is variation in bed rest times post procedure.

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How Does Your Cath Lab Stack Up? In this month’s article, we call on our colleagues at MedAxiom to share their findings from the 2016 Cath Lab Survey. The survey results demonstrate some very compelling findings that correlate closely to the ob-servations seen in assessments conducted by MedAxiom and Terumo Business Edge as part of our Cath Lab Care Pathway Program. Cath labs across the country share many of the same concerns and challenges. As a result of this extremely dynamic and fast-paced environment, cath labs are facing a wide variety of issues which make managing margins and reducing costs an added challenge, a theme that was prominent in the recently concluded JP Morgan Healthcare Conference. - Gary Clifton, Vice President, Terumo Business Edge

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space generated strong revenue and drove the cardiology service line to become one of the top performers on the hospi-tal balance sheet. However, since late 2008, when many procedures done in the cath lab began changing from inpatient work to outpatient work, the outpatient pay-ment transition dramatically reduced cath lab procedural revenue in many programs. Payment changes were not the only activity that caused cath labs to pay closer attention to margins. The improved outcomes from medical management and refined criteria for appropriate use of PCI also drove down the elective PCI numbers. Many cath labs found themselves, for the first time, operat-ing in the red when it came to net margin. In response to these considerable changes in cath lab finances, the survey posed a basic

questions about cost per case reporting and transparency (Figures 2-3).

Based on the results above, it is still diffi-cult for programs to measure cost per case. These results highlight the pressing need for programs to come to agreement on what costs are included and how this data will be used. Transparency in data is im-portant so context can be put around costs and ownership can be established.Costs cannot be reviewed in isolation from qual-ity data. Physicians need to have cost data aligned with quality data to drive standard-ization that achieves the highest quality outcomes at the lowest costs. We continue to hear from physicians about the need to become true partners in health care eco-nomics. System leaders that can work hand in hand with physicians, sharing financial

data, upside and downside risk, and more control will significantly increase physi-cian engagement. Programs that provide physicians with transparent data set the table for the right discussions. The culture must support a team effort led by both ad-ministrators and physicians.

With all the changes in the cath lab en-vironment, how are cath labs planning to achieve operational efficiency in the fu-ture (Figure 4)?

Many responding programs selected al-most all the options for program optimi-zation. The initiatives mentioned all have merit, but selecting one or two is more realistic. Here are some considerations that may help you focus on the right ini-tiative if your program has the following concerns or attributes:

Same-day discharge if your program has:• High radial adaption• System capacity issues• Diversion• Need for system cost avoidance

Radial program if your program needs:• Same-day discharge program• Site complication reduction

• AMI bundle site selection – improvedoutcomes for STEMI patients

• Improved patient experience• Lower cost per case than femoral access

Staffing redesign if your program can:• Leverage integrated EMRs between

the office and hospital• Partner with ambulatory sites and

reduce rework• Right size staff and care models for

outpatient procedures• Redeploy staff to new programs

Supply contracting system opportunities:• Investigate new purchasing groups• Ability to manage contracts as a service

line/system not just a cath lab• Ensure inventory management

practices are solid• Quality, outcomes and costs must all be

contracting considerations

Reduced clinical offerings for lowvolume, high cost programs:• Consolidation of a high cost program

with a partner (or)• Consolidation of program offerings

within a system

Figure 2. Question 25. Does your cath lab report cost per case by provider?Figure 3. Question 26. Is the cost per case report provided with transparency by provider name and case type?

Figure 4. Question 71. Is your cath lab considering any of the following to enhance operational performance? (Check all that apply)

Many cath labs found themselves, for the first time, operating in the red when it came to net margin.

System leaders that can work hand in hand with physicians, sharing financial data, upside and downside risk, and more control will significantly increase physician engagement.

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Examples:– Open heart surgery programs– Transcatheter aortic valve replacement– Ventricular assist devices– PCI

New program questions:• Is it offered in close proximity?• Is there a capital investment?• How do the projected financials look?• What are the personnel requirements?

Process improvement (PI) training needs:• Executive sponsor• PI expert/champion & supporting team• Funding

The cath lab environment has never been more dynamic or cost sensitive. Payment reform will require new tools and more discipline to work as a team while driving quality and reducing costs. What can be derived from the cath lab

survey is that programs know they must make adjustments to remain successful in the future. The survey responses also reflect a great opportunity for programs in both clinical and financial optimi-zation. The challenge is the resources needed to drive this kind of transforma-tion. A good example is same-day dis-charge for elective PCI patients. Despite compelling research on the safety of same-day discharge, adoption has been slow. Simply sending a patient home the day of service will lend a cost avoidance approximating $500.00 per event. In order to achieve a significantly greater cost savings, upwards of $3600.00 per event, (as referenced by Amin, et. al, CLD, Nov 2016) the care teams and processes around the PCI episode must be redesigned. Health care redesign is a complex and resource intensive process. What is clear is that programs investing in these efforts will be rewarded in new care models. n

Whether it is designing a new care pathway or refining your current processes, our team of experts has extensive experience in every phase of the cath lab care pathway.

Working with our strategic partner, MedAxiom Consulting, we will help you realize positive, quantifiable improvements and establish new processes that not only increase your operational efficiencies but will reduce your costs substantially. In a new era of bundles, it will be essential for your lab to have reliable, repeatable delivery of care.

To learn more, visit us at www.terumobusinessedge.com or contact us at info@terumobusinessedge.com.

A good example is same-day discharge for elective PCI patients. Despite compelling research on the safety of same-day discharge, adoption has been slow.

A survey is currently being drafted for release in early

Spring 2017. Next year’s survey will be shorter and the

benchmarking will offer more personalized feedback.

A special thank you to Cath Lab Digest readers that

completed the survey and we look forward to your

participation on the next survey.

Share your knowledge with 17,000+ readers of

Submit a manuscript to Cath Lab Digest

Instructions for authors are available at: www.cathlabdigest.com/author-guidelines

Questions? Contact the editor at rkapur@hmpcommunications.com

CLD has educated & informed cath lab professionals for over 20 years.

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