A delicate balancing act must arise between what is right for the patient, the physicians and the hospital budget. As a former cath lab manager, I am familiar with the daunting task of serving the needs of all involved. Clearly, technologies that have the greatest potential impact on patient outcomes should be our dominant consideration.
While most procedures and processes in the cath lab have real value and enhance patient care, many have been implemented without a critical assessment of the direct patient care impact or associated costs. For example, most labs have adopted the use of vascular closure devices without much scientific evidence demonstrating better patient outcomes or cost savings.
Each day cath labs are presented with new technology challenges. Few are as potentially transformational and emotionally charged as the anticipated introduction of drug-eluting stents. Hospitals will be pressed to find creative ways to implement this new technology and remain budget neutral. Finding ways to implement new technology, such as drug-eluting stents, should start with a thorough evaluation of current practices and supplies, and the value they provide to patient outcomes or lab efficiency. This evaluation may help identify opportunities for both clinical and financial improvement.
Current practices and treatment technologies can be rated using a value assessment tool. Working with a multi-disciplinary team of cath lab staff and physicians, you can develop a process to effectively evaluate your current (and future) practices and technologies against an objective set of criteria. A critical evaluation will help you place relative values and costs with each individual technology and/or practice.
Since the ultimate goal of treating patients is to provide therapy that reduces symptoms, improves the quality of life and provides long-term benefit, we should look closely at all current and future technologies that appear to support these goals. Utilization of an objective tool to facilitate evaluation of current and new technology may be helpful to groups making judgments on the merits of new devices and procedures and their importance to the cath lab in successfully treating patients. The tool may help answer the question: Does this really contribute to improving patient outcomes?
In my former role as a cath lab manager, I repeatedly faced the challenge of meeting the budgetary and utility needs of those involved in approving, implementing and receiving new therapies in the cath lab. Earlier this year, while still working in the cath lab, I was asked to evaluate additional opportunities to reduce our overall costs. Since we already had very aggressive contracts with several vendors, the chance of achieving any further price reductions seemed slim. As staff reductions were not an option, I began looking at some of our current practices to see if modifying the utilization of some products could achieve the desired goal. I looked closely at four products/therapies:
Our intravascular -brachytherapy program.
Armed with a spreadsheet listing the annual expenses and the savings that could be achieved with more thoughtful utilization by clinicians, I made my case to the medical director and administrator. The physicians agreed to be more selective in the use of these items. After just one month, we were able to achieve a $40,000 cost reduction in these four areas. This is not an insignificant impact when you annualize the savings. From this experience, and from listening to the challenges faced by other cath lab managers, I began to think about a process that might help others achieve similar success. This led to the development of a Technology Assessment Tool.
A Technology Assessment Tool (see Chart 1) not only helps identify the relative value of procedures and technologies, but can facilitate and stimulate discussions on other ways to improve patient care in your cath lab. By evaluating various procedures or products using a systematic and objective format, you will be able to quantify potential cost or time savings involved by the elimination of devices, practices or procedures that no longer bring added value to your patient or department. In addition, you will be able to justify current practices and their associated costs. This can be invaluable when you need to justify additional costs to your budget.
The sample tool presented here can be used as-is or customized with other products or critical evaluation questions in order to better match your specific situation. I have chosen to evaluate devices or technology based on the following criteria:
Is this a current or potential standard of care?
“ Is there sufficient evidence from clinical trials to justify this therapy?
Is this supported by clinical data?
“ Are there data to support that the therapy provides predictable, consistent outcomes?
Is there a potential legal or regulatory reason to continue this practice?
Does this enhance patient comfort or patient satisfaction?
Is there a cost and/or efficiency savings associated with this practice?
Is reimbursement available for the therapy?
After developing evaluation criteria, you can place a relative value on the practice or product using a scale of 0-5. (See Chart 2.) Once you rate each technology or practice, you can start to see how valuable each is to your daily operations, as well as be able to assign a financial cost to each activity. I used the criteria listed in Chart 2 in the sample Technology Assessment Tool.
Finding ways to reduce costs, improve efficiency and enhance patient care are all important and challenging tasks that cath lab managers must deal with on a daily basis. Having a defined method to provide an objective evaluation of current and future technology can be an invaluable tool, not only as a way to gather information from your clinicians, but also to initiate a process to facilitate acceptance to change. Without clinician buy-in, there is little opportunity for a cath lab manager to successfully implement change that balances the needs and expectations of all individuals. This assessment tool can also empower the cath lab manager with a collaborative, inclusive process that includes all relevant decision-makers.
As managers of cath labs, we must continually find ways to evaluate current and future treatment options. By using a scale similar to the one presented, each facility can more effectively evaluate treatments relative to their own patient population and program, weighing scientific evidence, need and cost.